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Reconstruction Puts Pieces of Cancer Patient's Life Back Together

February 23, 2016

Arun Sharma and Marilyn Herand

Arun Sharma, DDS, MS, chats with patient Marilyn Herand. Photo by Elisabeth Fall

By Bill Stein

For Marilyn Herand, surviving a rare mouth cancer was the easy part. The bigger question was what quality of life she would have after treatment.

Herand was diagnosed with a minor salivary gland tumor. The nature and location of the tumor ultimately required the surgical removal of all of her upper teeth, palate and upper jaw. Without a prosthesis, she wouldn’t be able to talk, eat or swallow.

“Sometimes what’s done to address the disease process of cancer can leave a patient without a good, functional quality of life,” said Arun Sharma, DDS, MS, clinical professor at UCSF. “Fortunately for Marilyn, we were able to bring back her functionality with a creative reconstructive effort.”

While having a functional quality of life is important for anyone, it was especially crucial for Herand, whose job as a coordinator for the Fulbright Visiting Scholar Enrichment Program in the Bay Area required considerable travel and frequent in-person interaction.

“I was in constant contact with scholars, local professors, arranging meetings, and speaking at meetings and seminars, so talking was an essential part of my position,” said Herand. “Without the obturator and the teeth that Dr. Sharma created, I would not be able to talk or be understood, and my mouth would pull to the inside without the prosthesis.”

Planning for the prosthesis was challenging. “We knew that Marilyn was not going to have enough teeth remaining to anchor a prosthesis but we couldn’t pursue a plan until after getting the final pathology on whether all the cancer was removed or not,” said Sharma. Depending on the success of the surgery, post-operative radiation therapy may have been necessary, which would have changed the course of specific reconstructive efforts.

Two options were considered. The first involved bone grafting and a much more invasive, longer surgery. The second option, the one ultimately pursued, was placing implants in an unusual area, the zygomatic arch, and having the prosthesis made on that.

Brian Schmidt, DDS, MD, PhD, placed Herand’s implants almost eight years ago. She comes to UCSF every few months for readjustment and remains free of cancer. By all measures, she is thriving.

“Every time I see Marilyn, it makes me feel good about what I’m doing,” Sharma said. “As a provider, when somebody comes in with the type of disease process that Marilyn had and you’re able to rehabilitate them and allow them to be a functional part of society again, you feel very satisfied about what you do.”